Limbal deficiency more common than realized

San Francisco-Limbal stem cell deficiency is more common than often recognized.

Contact lens wear, eye drops for glaucoma, treatment with mitomycin C, thermal trauma, and a variety of common events can cause limbal cell deficiency, said Edward Holland, MD, director of Cornea Service at the Cincinnati Eye Institute and professor at the University of Cincinnati in Cincinnati. One of the most important causes is clinicians who perform keratoplasty in an attempt to deal with complications of limbal stem cell loss.

“Patients with limbal deficiencies will not do well with keratoplasty,” Dr. Holland said.

“Even if you don’t treat patients with limbal cell deficiency, you need to be aware of the problem,” he said. “If you are following patients with contact lenses, dry eye, or long-term glaucoma meds, you need to think about your treatment and possibly changing it to deal with the problem.”

Patients with glaucoma, for example, can develop limbal stem cell deficiency from long-term use of eye drops. The solution: early intervention with shunts or other devices to reduce medication use. Patients who wear contact lenses may need to change lens types or avoid contacts altogether.

Other causes of limbal stem cell deficiency include inflammatory conditions, such as Stevens-Johnson syndrome or mucous membrane pemphigoid, or congenital conditions, such as aniridia. Whatever the cause, patients with limbal stem cell deficiency have persistent epithelial defects, corneal scarring and ulceration, conjunctivalization of the cornea, severe visual loss, and chronic pain.

In addition to reducing avoidable causes such as contact lens trauma, clinicians should consider both medical and surgical treatments. Medical options for mild limbal stem cell deficiency include preservative-free lubricants, bandage contact lenses or scleral contact lenses, topical steroids, topical vitamin A ointment, and autologous serum drops.

“Patients have options for visual recovery,” Dr. Holland said. “As clinicians, we need to recognize the early clinical signs of limbal stem cell deficiency and stop progression.”

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